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- Title
Nurse-led interventions used to improve control of high blood pressure in people with diabetes: a systematic review and meta-analysis.
- Authors
Clark, C. E.; Smith, L. F. P.; Taylor, R. S.; Campbell, J. L.
- Abstract
Background Previous reviews demonstrate uncertainty about the effectiveness of nurse-led interventions in the management of hypertension. No specific reviews in diabetes have been identified. We have systematically reviewed the evidence for effectiveness of nurse-led interventions for people with diabetes mellitus. Methods In this systematic review and meta-analysis, searches of Medline, Embase, CINAHL and the Cochrane Central Trials register were undertaken to identify studies comparing any intervention conducted by nurses in managing hypertension in diabetes with usual doctor-led care. Additional citations were identified from papers retrieved and correspondence with authors. Outcome measures were absolute systolic and diastolic blood pressure, change in blood pressure, proportions achieving study target blood pressure and proportions prescribed anti-hypertensive medication. Results Eleven studies were identified. Interventions included adoption of treatment algorithms, nurse-led clinics and nurse prescribing. Meta-analysis showed greater reductions in blood pressure in favour of any nurse-led interventions (systolic weighted mean difference)5.8 mmHg,95% CI)9.6 to)2.0; diastolic weighted mean difference)4.2 mmHg,95% CI)7.6 to )0.7) compared with usual doctor-led care. Nooverall superiority in achievement of study targets or in the use of medication was evident for any nurse-based interventions over doctor-led care. Conclusions There is some evidence for improved blood pressure outcomes with nurse-led interventions for hypertension in people with diabetes comparedwith doctor-led care. Nurse-based interventions require an algorithm to structure care and there is some preliminary evidence for better outcomes with nurse prescribing. Further work is needed to elucidate which nurse-led interventions are most effective.
- Subjects
DIABETES complications; HYPERTENSION; THERAPEUTICS; CHI-squared test; CINAHL database; CONFIDENCE intervals; INFORMATION storage &; retrieval systems; MEDICAL databases; MEDICAL information storage &; retrieval systems; MEDLINE; META-analysis; NURSES; HEALTH outcome assessment; SYSTEMATIC reviews; TREATMENT effectiveness
- Publication
Diabetic Medicine, 2011, Vol 28, Issue 3, p250
- ISSN
0742-3071
- Publication type
Article
- DOI
10.1111/j.1464-5491.2010.03204.x